Institutional Claims V1 Getting Started
Institutional Claims v1 API
The ASC X12N Health Care Claim: Institutional (837i) transaction enables healthcare providers to submit institutional healthcare claims for a service or an encounter. A healthcare claim includes patient information, related diagnoses, procedures performed or services provided, and any related charges. This API also translates the standard X12 EDI 837i transactions to JSON format so that it is more accessible to claim readers and developers.
NOTE
A single Institutional Claim supports up to 999 service line items.
Before sending to the payer, you can use the Institutional Claims Validation /institutionalclaims/v1/validation endpoint to check and validate your upcoming claim submission. Your transaction will not be sent to the payer. The validation does not examine the actual contents of your claim. It checks for the correct well-formed syntax of the submission and elements, such as correctly summing service line charges and verifying codes.
✍️ In the sandbox request, using value: test00005 (lower case and not uppercase), for
fieldName: patientControlNumber returns EDITS canned response.
NOTE
Optum also offers a more data-intensive Integrated Rules Institutional Claims API to check, analyze and correct Institutional Claims submissions. After this, use the standard Institutional Claims v1 API to submit your claims.
NOTE
- If you only plan to use a few daily transactions, you can use our ConnectCenter for your Medical Network transaction needs.
It provides most of the features supported by an API console but only allows manual entry for all data needed for a transaction. It contains Optum’s Payer Lists, the Payer List Enrollments wizard, and other API customer resources.- For providers sending hundreds of daily requests, we recommend using our APIs to be able to automate the submission processes and have a better fit for your business needs.
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Updated about 2 months ago